FOS Consultants
Our Expertise
FOS Consultants offer a wide range of services to meet your needs:
Medical Claims
Pharmacy Claims
FOS Consultants is an established leader in the medical claims cost containment industry. FOS Consultants offers state-of-the-art technology platform for REAL-TIME Claims Editing, Error Detection, Fraud Waste & Abuse.
We specialize in out-of-network medical claims and we have one of the largest networks in the country utilizing medical bill reviews, fee negotiations and a proprietary national travel wrap network. Also available are Reference Based pricing and a National U&C Database. FOS Consultants services TPA’s, health plans, self-insured companies, unions and reinsurers across the country.
FOS Consultants utilizes a proprietary AI pharmacy algorithms to identify areas of contract non-compliance, fraud, waste and abuse.
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Contract adherence and contract review
Therapeutic equivalance
Price benchmarking
Pricing variance analysis
Prescriber and patient detailing
Therapy compliance
Fraud, Waste and Abuse
PDL or formulary efficiency analysis
Speciality medication analysis
Clinical Interoperability
Connecting Health Plans with Provders, HIE's and EMR's. Reduce administrative costs and improve patient care coordination.
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Clinical data integration allows you to obtain clinical data from providers for care management, quality improvement, risk adjustment optimization, and payment integrity use cases.
Contract Negotiation
Are you negoitating a new purchase? Are you looking to sign or renegotiate a new MSA or SLSA? We can help. Many large companies try to force their standard terms and conditions upon customers. These agreements will set the relationship for years to come and could cost you millions of dollars if not handled properly. We can help.
Negotiating IT Maintenance Costs
IT Staffing
Health Plan Consulting
Provider Consulting
Health plan consulting helps organizations design, evaluate, and improve their health benefits and care delivery to meet member needs and business goals. Our team supports plan strategy, network and provider optimization, pricing and reimbursement analysis, utilization and quality improvement, and claims/process performance reviews to reduce waste and strengthen outcomes. We also guide plan implementation and change management—from regulatory and operational readiness to communication and training—so stakeholders can execute confidently and track results with clear metrics.
Provider consulting helps healthcare organizations improve performance across clinical operations, revenue cycle, and patient experience. We advise on practice and hospital strategy, service line planning, care delivery redesign, staffing and workflow optimization, and evidence-based quality and outcomes improvement. We also support financial and operational effectiveness through reimbursement and coding guidance, claims and denial reduction, KPI dashboards, and process streamlining to strengthen cash flow and reduce administrative burden. With hands-on engagement and measurable milestones, we guide providers from assessment through implementation—aligning teams, systems, and metrics to drive sustainable results.